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Sleep and Breathing

, Volume 17, Issue 2, pp 803–810 | Cite as

Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study

  • Kyunghun Kang
  • Ki-Soo Park
  • Ji-Eun Kim
  • Sung-Wan Kim
  • Young-Teak Kim
  • Jung-Soo Kim
  • Ho-Won LeeEmail author
Original Article

Abstract

Background

The Berlin Questionnaire (BQ) is a useful tool to identify the high-risk group for obstructive sleep apnea (OSA) in the primary care sites or hospital, but the usefulness of the BQ to identify the high-risk group for OSA in the general population has not been evaluated. The purpose of our study was to develop the Korean version of the BQ (KBQ) and evaluate the usefulness of the BQ in identifying patients with OSA in the general population.

Methods

A total of 1,305 subjects were included in a population-based door-to-door cross-sectional study. For validation of the KBQ, an overnight polysomnography (PSG) was performed on 101 subjects who were randomly selected considering their age, sex, and risk group classification at a controlled sleep laboratory.

Results

The KBQ showed a relatively good to excellent internal consistency (Cronbach’s α correlation 0.64–0.78) and test–retest reliability (intraclass correlation 0.92). The apnea–hypopnea index (AHI) was significantly correlated with the scores in each category and the total scores of the KBQ. In addition, high risk grouping based on the KBQ predicted an AHI ≥ 5 with a sensitivity of 0.69 and a specificity of 0.83. According to the risk categorization based on the KBQ, 26.1 % subjects were in the high-risk group for OSA which was similar to the prevalence of OSA in a previous large epidemiological study using PSG in Korea.

Conclusion

This is the first study to confirm the usefulness of the BQ as a screening tool for OSA by prioritizing subjects at high risk for OSA in the general population.

Keywords

Berlin Questionnaire Obstructive sleep apnea Sleep-disordered breathing Polysomnography General population Validity 

Notes

Acknowledgments

This research was supported by a grant of Korea Centers for Disease Control and Prevention, Republic of Korea (2009-E33029-00) and by Kyungpook National University Research Fund, 2012.

Conflict of interest

This was not an industry-supported study. The authors have indicated no financial conflicts of interest. There is no off-label or investigational use in this study.

References

  1. 1.
    Weinreich G, Plein K, Teschler T, Resler J, Teschler H (2006) Is the Berlin questionnaire an appropriate diagnostic tool for sleep medicine in pneumological rehabilitation? Pneumologie 60:737–742PubMedCrossRefGoogle Scholar
  2. 2.
    American Academy of Sleep Medicine (2005) International classification of sleep disorders: diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, WestchesterGoogle Scholar
  3. 3.
    Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D’Agostino RB, Newman AB, Lebowitz MD, Pickering TG (2006) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 283:1829–1836CrossRefGoogle Scholar
  4. 4.
    Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384PubMedCrossRefGoogle Scholar
  5. 5.
    Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (2005) Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 353:2034–2041PubMedCrossRefGoogle Scholar
  6. 6.
    Babu AR, Herdegen J, Fogelfeld L, Shott S, Mazzone T (2005) Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med 165:447–452PubMedCrossRefGoogle Scholar
  7. 7.
    Kim J, In K, Kim J, You S, Kang K, Shim J, Lee S, Lee J, Lee S, Park C, Shin C (2004) Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med 170:1108–1113PubMedCrossRefGoogle Scholar
  8. 8.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235PubMedCrossRefGoogle Scholar
  9. 9.
    Ohayon MM, Guilleminault C, Priest RG, Caulet M (1997) Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample. BMJ 314:860–863PubMedCrossRefGoogle Scholar
  10. 10.
    Young T, Evans L, Finn L, Palta M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20:705–706PubMedGoogle Scholar
  11. 11.
    Sharma SK, Vasudev C, Sinha S, Banga A, Pandey RM, Handa KK (2006) Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome. Indian J Med Res 124:281–290PubMedGoogle Scholar
  12. 12.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131:485–491PubMedCrossRefGoogle Scholar
  13. 13.
    Ahmadi N, Chung SA, Gibbs A, Shapiro CM (2008) The Berlin questionnaire for sleep apnea in a sleep clinic population: relationship to polysomnographic measurement of respiratory disturbance. Sleep Breath 12:39–45PubMedCrossRefGoogle Scholar
  14. 14.
    Dement WC, Netzer NC (2000) Primary care: is it the setting to address sleep disorders? [published erratum appears in Sleep Breath 2000;4:187-92]. Sleep Breath 4:1–9PubMedCrossRefGoogle Scholar
  15. 15.
    World Health Organization (WHO) Regional Office for the Western Pacific/International Association for the Study of Obesity/International Obesity Task Force (2000) The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia, Sydney, AustraliaGoogle Scholar
  16. 16.
    Iber C, Ancoli-Israel S, Chesson A, Quan S (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicine, WestchesterGoogle Scholar
  17. 17.
    Mok WY, Lam CL, Lam B, Cheung MT, Yam L, Ip MS (2004) A Chinese version of the Sleep Apnea Quality of Life Index was evaluated for reliability, validity, and responsiveness. J Clin Epidemiol 57:470–478PubMedCrossRefGoogle Scholar
  18. 18.
    Wiegand L, Zwillich CW (1994) Obstructive sleep apnea. Dis Mon 40:197–252PubMedCrossRefGoogle Scholar
  19. 19.
    Redline S, Tosteson T, Boucher MA, Millma RP (1991) Measurement of sleep-related breathing disturbances in epidemiologic studies. Assessment of the validity and reproducibility of a portable monitoring device. Chest 100:1281–1286PubMedCrossRefGoogle Scholar
  20. 20.
    Bliwise DL, Benkert RE, Ingham RH (1991) Factors associated with nightly variability in sleep-disordered breathing in the elderly. Chest 100:973–976PubMedCrossRefGoogle Scholar
  21. 21.
    Agnew HW Jr, Webb WB, Williams RL (1966) The first night effect: an EEG study of sleep. Psychophysiology 2:263–266PubMedCrossRefGoogle Scholar
  22. 22.
    Selwa LM, Marzec ML, Chervin RD, Weatherwax KJ, Vaughn BV, Foldvary-Schaefer N, Wang L, Song Y, Malow BA (2008) Sleep staging and respiratory events in refractory epilepsy patients: is there a first night effect? Epilepsia 49:2063–2068PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Kyunghun Kang
    • 1
  • Ki-Soo Park
    • 2
  • Ji-Eun Kim
    • 3
  • Sung-Wan Kim
    • 4
  • Young-Teak Kim
    • 5
  • Jung-Soo Kim
    • 6
  • Ho-Won Lee
    • 1
    • 7
    Email author
  1. 1.Department of Neurology, School of MedicineKyungpook National UniversityDaeguSouth Korea
  2. 2.Department of Preventive Medicine, School of Medicine and Institute of Health SciencesGyeongsang National UniversityGyeongsangnam-doSouth Korea
  3. 3.Department of Neurology, School of MedicineCatholic University of DaeguDaeguSouth Korea
  4. 4.Department of Otorhinolaryngology-Head and Neck Surgery, School of MedicineKyung Hee UniversitySeoulSouth Korea
  5. 5.Division of Chronic Disease ControlKorea Center for Disease Control & PreventionSeoulSouth Korea
  6. 6.Department of Otolaryngology-Head and Neck Surgery, School of MedicineKyungpook National UniversityDaeguSouth Korea
  7. 7.Department of Neurology, Brain Science and Engineering InstituteKyungpook National University School of MedicineDaeguSouth Korea

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